What is contact tracing?
Many countries are utilising the potential of digital epidemiology to monitor the epidemic trend and manage contact tracing operations. Italy is among this group and works hard to integrate these new technologies with the monitoring data from the National Institute of Health. In the past the contact tracing investigation used to take place manually- with other diseases such as tuberculosis or measles- but today there is an unprecedented challenge. Sars-Cov-2 spreads very fast in large populations so tracing the contacts of a huge number of people in a small amount of time put the manual analysis system, that the relevant healthcare authorities of the territory were used, to on their knees. Contact tracing- the identification of cases and their close contacts, with the relative isolation and distancing- is currently is the only way to mitigate the pandemic. If we manage to quickly identify the infected individuals and those that came in contact with them, and do this well, we can reduce the spread and in the best-case scenario even stop it. It is really difficult to keep these operations going when multiple outbreaks happen at the same time, hence why it is necessary to utilise technologies like the apps.
What are we referring to when we talk about apps?
Although the availability of bed spaces in intensive care units varies between countries, there is no healthcare system in the world that would be able to function with a never-ending increase of cases that require intensive care. For this reason it is not reasonable to just plan the increase of bed spaces in intensive care units. In order to avoid overwhelming the healthcare system it becomes absolutely necessary to adopt measures that contain the spread of the infection. We achieved this through the measures imposed around social distancing, but the economic and political cost of this is very high and leads to complex social issues. It is therefore necessary to adopt less drastic measures that will still allow to mitigate the spread of the virus between people.
Together, readiness and technology can hold a central role in the control of the spread of the virus.
In this context the approach that South Korea adopted to limit the spread of the infection raised a lot of interest. The South Korean model of isolating and tracing the infected people and their contacts was particularly well organised and prevented the lockdown of entire cities. Even though new outbreaks might emerge, so far the example of South Korea is teaching that together, readiness and technology can hold a central role in the control of the spread of the virus. For this reason, in order to guarantee an effective containment, it would be necessary to combine the social isolation of the individual who tested positive to Covid-19 with the proactive research of their contacts network. First of all the app should be installed before the person gets sick, so that we can know and understand in a timely manner how many people they come in contact with and the evolution of the infection. Thanks to the list of telephones that the subject came in contact with it is actually possible to create in real time a list of people to contact immediately, giving them precise directions on how to behave and asking them to stay in quarantine. The South Korean system also includes the collection and analysis of data around the use of credit cards and the study of telephone cells to check the movements of individuals. However, all of this would not be feasible in our country and Europe in general for obvious issues around confidentiality.
Several doubts were raised around the use of this type of app concerning the European legislation on confidentiality and data protection. However, significant efforts have been made in Europe to try and safeguard as much as possible the confidentiality of the app users. Once this app is introduced to people they will be free to activate it or not, and obviously the more people do this the better the system will work. In terms of communication it is very important that this part gets strongly highlighted. The collected data will be utilised exclusively for healthcare purposes and once all the contacts have been traced and the quarantine period is over the application will automatically stop storing all the information. Furthermore, if the individual decides not to provide consent their data will be stored in their device and won’t be transmitted to the healthcare authority; if they then get sick their contacts will be alerted.
The app is not enough on its own. What else is required?
This tool cannot completely substitute the monitoring activities but should be integrated to an operative plan that includes the general modernisation of the entire system. For example, there should be a quicker passage of information from the laboratory to the investigation coordinator, resulting in a fast communication with the quarantined subject as well. We cannot rely on all this information being recorded on paper; we need flexible and quick information systems that are also integrated (for example with the municipal registry, so that the personal data of each case doesn’t have to be re-recorded as it is already on their database). All of this will allow the numerous healthcare workers, which work on investigations throughout the territory, not to spend hours on end filling in personal information forms. The priority should be to make this process quicker and computerised and once this happens the app will really be able to function. Technology will therefore prove helpful to oil the wheels of this system and to obtain better data, as well as guaranteeing a useful service for the population and mitigating the spread whenever there are outbreaks.
What should be done for it to work?
Distancing is essential to mitigate the spread and it’s evident that we won’t be able to test everyone, so the people who came in contact with confirmed cases will have to be asked to stay home. Naturally this scenario will have to be organised in a detailed manner. This system should be put in place homogenously throughout Italy following a national standard so that every region does not self-organise based on their individual capacity and planning ability. Contact tracing operations should be guaranteed throughout the national territory in order to tackle inequalities and technology can definitively help to make this system work.
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